Online prelicensure nursing students' experiences of academic incivility during COVID-19: A qualitative inquiry.

AIM: The aim of this study was to describe online prelicensure nursing students' experiences of incivility during COVID-19. DESIGN: Qualitative descriptive. Five optional open-ended questions were presented to nursing students to share their experiences with incivility during the pandemic. METHODS: Data were collected from September to October 2020 as a part of a larger multimethod study on stress, resilience and incivility with nursing students and faculty (n = 710) from a large public undergraduate nursing programme in the southwestern United States. Out of the initial 675 students who completed the survey, 260 individuals responded to three or more of the open-ended questions which were reviewed and coded using reflexive thematic analysis. RESULTS: Thirteen themes were organized into four analytical categories: (1) experiencing incivility, (2) causes and consequences of incivility, (3) the pandemic and academic incivility and (4) promoting civility in the academic setting. CONCLUSIONS: Prelicensure nursing students perceived unrealistic expectations, a lack of awareness and miscommunication hindered academic performance, as well as, created feelings of stress, discouragement and inadequacy. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Fostering academic civility during virtual educational experiences may require training in proper coping strategies when challenged with incivility. IMPACT: As the body of research emerges concerning the effects of COVID-19 and undergraduate nursing education, understanding prelicensure students' experiences of academic incivility could prove to be beneficial to designing strategies co-created with students to promote positive educational outcomes. Understanding students' viewpoints of uncivil experiences revealed prioritizing civility awareness is essential in creating healthy academic environments, improving clinical performance and providing safe patient care. REPORTING METHOD: The COREQ (COnsolidated criteria for REporting Qualitative research) checklist was used. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Geospatial data from a global survey of martian fan-shaped sedimentary landforms.

Data in this article are related to the research article "The global distribution and morphologic characteristics of fan-shaped sedimentary landforms on Mars". We used globally available image and topographic data to document the location of every fan-shaped sedimentary landform on the surface of Mars. We mapped fan outlines and associated drainage basins and collected a number of morphologic metrics. These data can be used as a boundary condition for studies of global scale studies of Mars, including climate and hydrologic modeling. Data files publicly available on Figshare include point shapefile of fan apices, and polygon shapefiles of fan outlines and drainage basins.

Changing spatial distribution of water flow charts major change in Mars's greenhouse effect.

Early Mars had rivers, but the cause of Mars's wet-to-dry transition remains unknown. Past climate on Mars can be probed using the spatial distribution of climate-sensitive landforms. We analyzed global databases of water-worked landforms and identified changes in the spatial distribution of rivers over time. These changes are simply explained by comparison to a simplified meltwater model driven by an ensemble of global climate model simulations, as the result of ≳10 K global cooling, from global average surface temperature [Formula: see text] ≥ 268 K to [Formula: see text] ~ 258 K, due to a weaker greenhouse effect. In other words, river-forming climates on early Mars were warm and wet first, and cold and wet later. Unexpectedly, analysis of the greenhouse effect within our ensemble of global climate model simulations suggests that this shift was primarily driven by waning non-CO2 radiative forcing, and not changes in CO2 radiative forcing.

Association of stress, resilience, and nursing student incivility during COVID-19.

Although incivility in nursing education is linked with negative physical and psychological effects on students, it is unclear how resilience and stress interact and relate to student incivility. The purpose was to understand the role of resilience and stress with peer incivility in a sample of prelicensure nursing students during coronavirus disease 2019. The study design was cross-sectional and correlational. Data were from an online survey administered to undergraduate nursing students of one college of nursing in a southwestern US state during September-October 2020. In a sample of 490 students, ordinal regression model results supported that including a stress and resilience interaction term resulted in a nonsignificant effect of stress and resilience, as the main effect correlates on low-level uncivil student behavior. More research is needed to understand the prevalence of stress and resilience at different points in prelicensure nursing education so that targeted interventions can be developed and deployed to assist students.

Lab-scale and full-scale industrial composting of biodegradable plastic blends for packaging.

Background: The acceptance of compostable plastic packaging in industrial composting plants is not universal despite available certification due to the persistence of plastic residues after composting. To better understand this discrepancy, this study compared the disintegration rates of two blends designed for rigid packaging (polylactic acid based) and soft packaging (polybutylene succinate based) in lab-scale composting tests and in an industrial composting plant. Methods: A lab-scale composting test was conducted in triplicates according to ISO 20200 for 4, 8 and 12 weeks to check the disintegration potential of the blends. Duplicate test material were then exposed in the compost pile of an industrial composting plant for a duration of 3 weeks and compared with a supplementary lab-scale test of the same duration. Results: The rigid packaging samples (1 mm thickness) retained on average 76.4%, 59.0% and 55.7% of its mass after 4, 8 and 12 weeks respectively in the lab-scale. In the plant, the average remaining mass was 98.3%, much higher compared to the average of 68.9% after 3 weeks in the supplementary lab-scale test. The soft packaging samples (109±9 µm sample thickness) retained on average 45.4%, 10.9% and 0.3% of its mass after 4, 8 and 12 weeks respectively in the lab-scale. In the plant, a high average remaining mass was also observed (93.9%). The supplementary lab-scale test showed similar remaining mass but higher fragmentation after 3 weeks. Conclusions: The results show that the samples achieved significant disintegration in the lab-scale but not in the plant. The difference between the tests that might further contribute to the differing degradation rates is the composition and heterogeneity of the composting substrate. Therefore, the substrate composition and thermophilic composting duration of individual plants are important considerations to determine the suitability of treating compostable plastic in real-world conditions.

There is resistance from industrial composting plants to the treatment of compostable biodegradable plastics. This study aims to compare the disintegration rates of two new biodegradable plastic blends developed for rigid and soft packaging applications in controlled industrial composting conditions in the lab as well as under actual industrial composting conditions in a composting plant. Results show significant disintegration of the material in the lab-scale up to 12 weeks. However, there were notable differences in the degree of disintegration of the samples in the lab compared to real-world conditions after 3 weeks. The 1 mm thick polylactic acid-based blend for rigid packaging experienced much higher disintegration in the lab with 68.9% remaining mass after 3 weeks compared to 97.2% remaining mass in the industrial composting plant. The 109 µm thick polybutylene succinate-based blend for soft packaging had similar remaining masses comparing the lab and full-scale tests. However, the lab-test showed higher fragmentation after 3 weeks. The characteristics of the organic waste inputs are potential causes of the lower disintegration rates. The study highlights the need to better understand the real-world industrial composting conditions and their variations when evaluating composting as a treatment method for biodegradable plastics.

Relationships among stress, resilience, and incivility in undergraduate nursing students and faculty during the COVID-19 pandemic: Policy implications for nurse leaders.

BACKGROUND: Developing successful targeted interventions to reduce incivility for undergraduate nursing students and educators will require understanding the differences in their unique experiences. Although resilience may act as protective buffer against stressors, little is known about the relationships between stress, resilience, and perceptions of the frequency of incivility in the academic environment. PURPOSE: The purpose of this study was to compare relationships among and differences between perceptions of incivility frequency and self-reported stress and resilience levels in undergraduate nursing students and faculty during the COVID-19 pandemic. METHOD: A comparative descriptive and correlational research design was utilized. An online survey was used to collect data from undergraduate nursing students and faculty (n = 710) at one public university. RESULTS: Students were significantly more stressed and less resilient than faculty. Faculty reported significantly greater low and high-level student and low-level faculty incivility behaviors than students. CONCLUSION: Understanding student and faculty perceptions of uncivil behavior frequency occurring at the intersection of high stress and moderate resilience levels is key to the creation of targeted interventions and policy development.

Meeting the challenge: Implementation of a collaborative quality improvement initiative for a multi-site pharmacy residency and fellowship program.

INTRODUCTION: The American Society of Health-System Pharmacists (ASHP) accreditation standards for postgraduate training programs require a continuous improvement plan as a method of quality improvement (QI). The University of Maryland (UM) Residency and Fellowship Program offers several residency and fellowship programs. The primary objective of this QI project was to assess the perceived effectiveness of the UM's training program in preparing trainees for their desired career goals. A secondary objective was to acquire suggestions from graduates to assist in QI. METHODS: A 12-question electronic survey was sent to UM residents and fellows who graduated between 2012 and 2016. Survey questions addressed the graduate's perception of their training experience. Graduates were also asked how well certain skills were taught based on core ASHP requirements. Participation was voluntary and responses were anonymous. RESULTS: Seventy-five graduates were identified for potential inclusion, and 43 (57%) completed the survey. Findings revealed 88% of graduates were practicing in a position that matched their training and 95% indicated that their program prepared them adequately for their current job. CONCLUSIONS: The ASHP accreditation standards for pharmacy residency programs require an ongoing process of QI. This study provides support for use of an electronic survey as a helpful tool to assess effectiveness of a residency program.

Understanding the role of Facebook to support women with endometriosis: A Malaysian perspective.

AIMS: To examine the pertinent issues discussed by endometriosis patients in Malaysia on MyEndosis Facebook group as an alternative platform for online support. METHODS: Using thematic analysis based on three frameworks, 120 posted messages and comments were examined from MyEndosis Facebook group-a support group for women with endometriosis from January to July 2014. RESULTS: Results showed the issues discussed were (a) personal struggles, (b) medication and treatment, (c) alternative medication, (d) side effects, and (e) medication recommended by doctors. While using this social medium, users found (a) emotional support, (b) esteem support, (c) information support, (d) network support, and (e) tangible assistance in their engagement with others. CONCLUSION: The analysis suggested that users' interactions were structured around information, emotion, and community building, which many doctors and nurses were not aware of. The group was shaped as a social network where peer users share social support, cultivate companionship, and exert social influence.

Persistence of intense, climate-driven runoff late in Mars history.

Mars is dry today, but numerous precipitation-fed paleo-rivers are found across the planet's surface. These rivers' existence is a challenge to models of planetary climate evolution. We report results indicating that, for a given catchment area, rivers on Mars were wider than rivers on Earth today. We use the scale (width and wavelength) of Mars paleo-rivers as a proxy for past runoff production. Using multiple methods, we infer that intense runoff production of >(3-20) kg/m2 per day persisted until <3 billion years (Ga) ago and probably <1 Ga ago, and was globally distributed. Therefore, the intense runoff production inferred from the results of the Mars Science Laboratory rover was not a short-lived or local anomaly. Rather, precipitation-fed runoff production was globally distributed, was intense, and persisted intermittently over >1 Ga. Our improved history of Mars' river runoff places new constraints on the unknown mechanism that caused wet climates on Mars.

Real-time colour pictorial radiation monitoring during coronary angiography: effect on patient peak skin and total dose during coronary angiography.

AIMS: The aim of this study was to evaluate whether a real-time (RT) colour pictorial radiation dose monitoring system reduces patient skin and total radiation dose during coronary angiography and intervention. METHODS AND RESULTS: Patient demographics, procedural variables and radiation parameters were recorded before and after institution of the RT skin dose recording system. Peak skin dose as well as traditionally available measures of procedural radiation dose were compared. A total of 1,077 consecutive patients underwent coronary angiography, of whom 460 also had PCI. Institution of the RT skin dose recording system resulted in a 22% reduction in peak skin dose after accounting for confounding variables. Radiation dose reduction was most pronounced in those having PCI but was also seen over a range of subgroups including those with prior coronary artery bypass surgery, high BMI, and with radial arterial access. This was associated with a significant reduction in the number of patients placed at risk of skin damage. Similar reductions in parameters reflective of total radiation dose were also demonstrated after institution of RT radiation monitoring. CONCLUSIONS: Institution of an RT skin dose recording reduced patient peak skin and total radiation dose during coronary angiography and intervention. Consideration should be given to widespread adoption of this technology.

Dyspnea in a Hospitalized Patient: Using Simulation to Introduce Interprofessional Collaborative Practice Concepts.

INTRODUCTION: Improved team communication is essential in preventing errors in patient care. Based on TeamSTEPPS concepts, we developed this simulation case scenario to engage learners from various health care professions in interprofessional teamwork. The case was developed for graduating medical, physician assistant, and nursing students with clinical experience, as well as pharmacy students just beginning clinical rotations. METHODS: Learners are evenly distributed into groups based on their professional training to provide an opportunity to function as a team. Faculty receive case materials prior to the day they will be volunteering and receive just-in-time training to refresh medical management knowledge and to prepare them for interprofessional facilitation, debriefing, and team skills. Faculty start by introducing interprofessional teamwork skills based on TeamSTEPPS concepts and providing an activity in which teams compete to create the longest paper chain. Next, faculty run a scenario featuring a standardized patient or high-fidelity manikin developing dyspnea in a simulated hospital setting. Learners can use skills from their profession-specific education as well as theoretical knowledge while demonstrating interprofessional communication skills during the simulation. RESULTS: Overall, 1,475 students have been trained with this resource over the last 5 years. Evaluations completed by learners postsimulation have rated this resource favorably. This resource has equivalent outcomes to two other scenarios also in the workshop series, indicating that using this resource alone will meet the workshop objectives. DISCUSSION: This simulation experience advances the work of interprofessional education in developing increased self-efficacy in learners to be able to implement team skills and work in an interprofessional team.

Twenty-Four Hour Ex Vivo Culture of Celiac Duodenal Biopsies.

Organ culture is a valuable technique in celiac disease research. It provides the opportunity to examine interactions between different cell types during the disease process without the need for invasive in vivo studies. Biopsies are maintained in an oxygen-rich environment, in contact with, but not submerged in, culture medium. A very straightforward and successful method of organ culture is described here.

Takotsubo cardiomyopathy and 5-Fluorouracil: getting to the heart of the matter.

Takotsubo cardiomyopathy is a rare but increasingly recognized phenomenon, which can occur as a side-effect of chemotherapeutic agents, in particular, the antimetabolite 5-fluorouracil. We describe a case of delayed Takotsubo cardiomyopathy after 3 weeks of adjuvant 5-fluorouracil for resected rectal adenocarcinoma in a 66-year-old female, supported by angiographic, electrocardiographic, and echocardiographic features. As a complication, she developed an apical mural thrombus with subsequent cerebral thromboembolic events and was successfully anticoagulated to make a full recovery. We present a review of the literature on Takotsubo cardiomyopathy secondary to 5-fluorouracil and the rare occurrence of thromboembolic complications. As this is a significant clinical phenomenon which involves a multispeciality approach to management, oncologists and cardiologists need to recognize it as a potential toxicity of a widely administered chemotherapeutic drug.

Interprofessional education in team communication: working together to improve patient safety.

BACKGROUND: Communication failures in healthcare teams are associated with medical errors and negative health outcomes. These findings have increased emphasis on training future health professionals to work effectively within teams. The Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) communication training model, widely employed to train healthcare teams, has been less commonly used to train student interprofessional teams. The present study reports the effectiveness of a simulation-based interprofessional TeamSTEPPS training in impacting student attitudes, knowledge and skills around interprofessional communication. METHODS: Three hundred and six fourth-year medical, third-year nursing, second-year pharmacy and second-year physician assistant students took part in a 4 h training that included a 1 h TeamSTEPPS didactic session and three 1 h team simulation and feedback sessions. Students worked in groups balanced by a professional programme in a self-selected focal area (adult acute, paediatric, obstetrics). Preassessments and postassessments were used for examining attitudes, beliefs and reported opportunities to observe or participate in team communication behaviours. RESULTS: One hundred and forty-nine students (48.7%) completed the preassessments and postassessments. Significant differences were found for attitudes toward team communication (p<0.001), motivation (p<0.001), utility of training (p<0.001) and self-efficacy (p=0.005). Significant attitudinal shifts for TeamSTEPPS skills included, team structure (p=0.002), situation monitoring (p<0.001), mutual support (p=0.003) and communication (p=0.002). Significant shifts were reported for knowledge of TeamSTEPPS (p<0.001), advocating for patients (p<0.001) and communicating in interprofessional teams (p<0.001). CONCLUSIONS: Effective team communication is important in patient safety. We demonstrate positive attitudinal and knowledge effects in a large-scale interprofessional TeamSTEPPS-based training involving four student professions.

Higher incidence of acute kidney injury with intravenous colistimethate sodium compared with polymyxin B in critically ill patients at a tertiary care medical center.

Nephrotoxicity was assessed in 173 critically ill patients receiving intravenous colistin or polymyxin B; it occurred in 60.4% and 41.8%, respectively. Further investigation is necessary to elucidate the reason for the difference in nephrotoxicity observed between the groups and to assess the impact of severity of illness and dosing/administration.

Interprofessional education in team communication: working together to improve patient safety.

BACKGROUND: Communication failures in healthcare teams are associated with medical errors and negative health outcomes. These findings have increased emphasis on training future health professionals to work effectively within teams. The Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) communication training model, widely employed to train healthcare teams, has been less commonly used to train student interprofessional teams. The present study reports the effectiveness of a simulation-based interprofessional TeamSTEPPS training in impacting student attitudes, knowledge and skills around interprofessional communication. METHODS: Three hundred and six fourth-year medical, third-year nursing, second-year pharmacy and second-year physician assistant students took part in a 4 h training that included a 1 h TeamSTEPPS didactic session and three 1 h team simulation and feedback sessions. Students worked in groups balanced by a professional programme in a self-selected focal area (adult acute, paediatric, obstetrics). Preassessments and postassessments were used for examining attitudes, beliefs and reported opportunities to observe or participate in team communication behaviours. RESULTS: One hundred and forty-nine students (48.7%) completed the preassessments and postassessments. Significant differences were found for attitudes toward team communication (p<0.001), motivation (p<0.001), utility of training (p<0.001) and self-efficacy (p=0.005). Significant attitudinal shifts for TeamSTEPPS skills included, team structure (p=0.002), situation monitoring (p<0.001), mutual support (p=0.003) and communication (p=0.002). Significant shifts were reported for knowledge of TeamSTEPPS (p<0.001), advocating for patients (p<0.001) and communicating in interprofessional teams (p<0.001). CONCLUSIONS: Effective team communication is important in patient safety. We demonstrate positive attitudinal and knowledge effects in a large-scale interprofessional TeamSTEPPS-based training involving four student professions.

HIV and pregnancy: challenges in practice.

Midwives face great challenges in practice in caring for women with multiple medical, social and psychological needs. This article highlights the issues such as extreme grief reaction, fear of abandonment and stigma and prejudice that women face when they are diagnosed HIV positive during pregnancy. The article also discusses the importance of communication and a multi-agency approach in providing safe antenatal care for vulnerable women and their families.

An initial description of a sonographic sign that verifies intrathoracic chest tube placement.

PURPOSE: An initial description of a sonographic finding predictive of intrathoracic chest tube placement. METHODS: This was a prospective observational study using unembalmed cadaveric models. Chest tubes were randomly placed intra- and extrathoracically and evaluated using ultrasound. Chest tube location was confirmed using blunt dissection followed by tactile and visual confirmation. Sonographers were blinded to chest tube position. Sonographic images obtained in a transverse orientation revealed a subcutaneous hyperechoic arc, created by the chest tube, at the insertion site. The path of the hyperechoic arc was followed cephalad. Disappearance of the hyperechoic arc signified intrathoracic chest tube placement. In contrast, continuation of a subcutaneous hyperechoic arc for the full length of the chest tube signified extrathoracic chest tube placement (the Disappearance/Intrathoracic, Continuation/Extrathoracic sign). RESULTS: Ultrasound was used to evaluate 48 chest tube placements. All chest tube locations were identified correctly. In differentiating intra- vs extrathoracic chest tube placement, the Disappearance/Intrathoracic, Continuation/Extrathoracic sign revealed a sensitivity of 100% (95% confidence interval, 83%-100%) and a specificity of 100% (95% confidence interval, 83%-100%). CONCLUSIONS: In this small study, bedside ultrasound appears to be highly sensitive and specific in differentiating intra- versus extrathoracic chest tube placement.